The arteriovenous access stage (AVAS) classification

Abstract Background Key anatomical factors mean that individuals needing arteriovenous access are unique and have different possibilities for fistula creation. The aim of this article is to describe a new classification system for all patients needing haemodialysis vascular access in the upper extremity with the purpose to simplify sharing the information about suitability for surgical access creation depending on vascular anatomy. Methods According to the patient’s vascular anatomy in right and left superior extremities, patients were separated into three arteriovenous access stages (AVAS). The AVAS was validated by three blinded observers using a sample of 70 upper limb arteriovenous maps that were performed using ultrasound on patients referred for vascular access assessment. A sample size calculation was performed and calculated that for three observers, a minimum of 67 maps were required to confirm significant agreement at a Kappa value of 0.9 (95% confidence interval 0.75–0.99). Results The Kappa value for inter-rater reliability using Fleiss’ Kappa coefficient was 0.94 and all patients fitted into the AVAS classification system. Conclusion The AVAS classification system is a simplified way to share information about vascular access options based on a patient’s vascular anatomy with high inter-rater reliability.

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Comprehensive classification system for multirod constructs across three-column osteotomies: a reliability study

Journal of Neurosurgery Spine ◽

10.3171/2020.6.spine20678 ◽

2021 ◽

Vol 34 (1) ◽

pp. 103-109

Author(s):

Mostafa H. El Dafrawy ◽

Owoicho Adogwa ◽

Adam M. Wegner ◽

Nicholas A. Pallotta ◽

Michael P. Kelly ◽

...

Keyword(s):

Classification System ◽

Interobserver Reliability ◽

Kappa Coefficient ◽

Intraobserver Reliability ◽

Osteotomy Site ◽

New Classification ◽

Good Reliability ◽

Kappa Value ◽

Comprehensive Classification ◽

High Degree

OBJECTIVEIn this study, the authors’ goal was to determine the intra- and interobserver reliability of a new classification system that allows the description of all possible constructs used across three-column osteotomies (3COs) in terms of rod configuration and density.METHODSThirty-five patients with multirod constructs (MRCs) across a 3CO were classified by two spinal surgery fellows according to the new system, and then were reclassified 2 weeks later. Constructs were classified as follows: the number of rods across the osteotomy site followed by a letter corresponding to the type of rod configuration: “M” is for a main rod configuration, defined as a single rod spanning the osteotomy. “L” is for linked rod configurations, defined as 2 rods directly connected to each other at the osteotomy site. “S” is for satellite rod configurations, which were defined as a short rod independent of the main rod with anchors above and below the 3CO. “A” is for accessory rods, defined as an additional rod across the 3CO attached to main rods but not attached to any anchors across the osteotomy site. “I” is for intercalary rod configurations, defined as a rod connecting 2 separate constructs across the 3CO, without the intercalary rod itself attached to any anchors across the osteotomy site. The intra- and interobserver reliability of this classification system was determined.RESULTSA sample estimation for validation assuming two readers and 35 subjects results in a two-sided 95% confidence interval with a width of 0.19 and a kappa value of 0.8 (SD 0.3). The Fleiss kappa coefficient (κ) was used to calculate the degree of agreement between interrater and intraobserver reliability. The interrater kappa coefficient was 0.3, and the intrarater kappa coefficient was 0.63 (good reliability). This scenario represents a high degree of agreement despite a low kappa coefficient. Correct observations by both observers were 34 of 35 and 33 of 35 at both time points. Misclassification was related to difficulty in determining connectors versus anchors.CONCLUSIONSMRCs across 3COs have variable rod configurations. Currently, no classification system or agreement on nomenclature exists to define the configuration of rods across 3COs. The authors present a new, comprehensive MRC classification system with good inter- and intraobserver reliability and a high degree of agreement that allows for a standardized description of MRCs across 3COs.

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Vascular anatomy of the medial sural artery perforator flap: A new classification system of intra-muscular branching patterns

Journal of Plastic Reconstructive & Aesthetic Surgery ◽

10.1016/j.bjps.2014.05.016 ◽

2014 ◽

Vol 67 (9) ◽

pp. 1267-1275 ◽

Cited By ~ 24

Author(s):

Joseph R. Dusseldorp ◽

Quy J. Pham ◽

Quan Ngo ◽

Mark Gianoutsos ◽

Pouria Moradi

Keyword(s):

Classification System ◽

Vascular Anatomy ◽

Perforator Flap ◽

New Classification ◽

Branching Patterns ◽

Sural Artery ◽

Artery Perforator

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Ischaemic stroke etiological classification system: the agreement analysis of CISS, SPARKLE and TOAST

Stroke and Vascular Neurology ◽

10.1136/svn-2018-000226 ◽

2019 ◽

Vol 4 (3) ◽

pp. 123-128 ◽

Cited By ~ 1

Author(s):

Haojie Zhang ◽

Zixiao Li ◽

Yunyi Dai ◽

Enhui Guo ◽

Changqing Zhang ◽

...

Keyword(s):

Ischemic Stroke ◽

Ischaemic Stroke ◽

Classification System ◽

High Reliability ◽

Classification Systems ◽

Rater Reliability ◽

Stroke Classification ◽

Subtype Classification ◽

Stroke Research ◽

Kappa Value

Background and purposeThe ideal stroke classification system needs to have validity, high reliability and applicability among different stroke research settings. The Chinese Ischemic Stroke Subclassification (CISS) and the Subtypes of Ischemic Stroke Classification System (SPARKLE) have emerged recently but have not been tested using agreement analysis. As a result, the objective of this study is to investigate the level of agreement among stroke subtype classifications using CISS, SPARKLE and Trial of Org 10172 in Acute Stroke Treatment (TOAST). We also analyse the inter-rater reliability of CISS.MethodsThe data include 623 inpatients who have had an ischaemic stroke, accrued from Beijing Tiantan Hospital between 1 October 2015 and 19 April 2016. According to the diagnostic standards of the three subtype classification systems, 299 inpatients who satisfied the requirements of our study were independently classified with etiological subtypes, and we compared the three subclassifications.ResultsThere was substantial overall agreement among the three classification systems: CISS versus SPARKLE (kappa value=0.684, p<0.001), CISS versus TOAST (kappa value=0.615, p<0.001) and SPARKLE versus TOAST (kappa value=0.675, p<0.001). The inter-rater reliability of CISS was excellent (kappa value=0.857, p<0.001). Furthermore, among the three subtype classification systems, the variance analysis results of the etiological subtypes were not uniform.ConclusionThere were generally substantial agreements among three ischaemic stroke etiological classification systems. CISS is a valid and reliable classification system, with which different stroke research centres can apply and compare data.

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Surgical configurations of the pectoralis major flap for reconstruction of sternoclavicular defects: a systematic review and new classification of described techniques

BMC Surgery ◽

10.1186/s12893-019-0604-7 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 3

Author(s):

Jude Opoku-Agyeman ◽

David Matera ◽

Jamee Simone

Keyword(s):

Classification System ◽

English Language ◽

Vascular Anatomy ◽

Sternoclavicular Joint ◽

Pectoralis Major ◽

Cochrane Library ◽

New Classification ◽

Pectoralis Major Flap ◽

Thoracoacromial Artery ◽

Defect Reconstruction

Abstract Objectives The pectoralis major flap has been considered the workhorse flap for chest and sternoclavicular defect reconstruction. There have been many configurations of the pectoralis major flap reported in the literature for use in reconstruction sternoclavicular defects either involving bone, soft tissue elements, or both. This study reviews the different configurations of the pectoralis major flap for sternoclavicular defect reconstruction and provides the first ever classification for these techniques. We also provide an algorithm for the selection of these flap variants for sternoclavicular defect reconstruction. Methods EMBASE, Cochrane library, Ovid medicine and PubMed databases were searched from its inception to August of 2019. We included all studies describing surgical management of sternoclavicular defects. The studies were reviewed, and the different configurations of the pectoralis major flap used for sternoclavicular defect reconstruction were cataloged. We then proposed a new classification system for these procedures. Results The study included 6 articles published in the English language that provided a descriptive procedure for the use of pectoralis major flap in the reconstruction of sternoclavicular defects. The procedures were classified into three broad categories. In Type 1, the whole pectoris muscle is used. In Type 2, the pectoralis muscle is split and either advanced medially (type 2a) or rotated (type 2b) to fill the defect. In type 3, the clavicular portion of the pectoralis is islandized on a pedicle, either the thoracoacromial artery (type 3a) or the deltoid branch of the thoracoacromial artery (type 3b). Conclusion There are multiple configurations of the pectoralis flap reported in the English language literature for the reconstruction of sternoclavicular defects. Our classification system, the Opoku Classification will help surgeons select the appropriate configuration of the pectoralis major flap for sternoclavicular joint defect reconstruction based on size of defect, the status of the vascular anatomy, and acceptability of upper extremity disability. It will also help facilitate communication when describing the different configurations of the pectoralis major flap for reconstruction of sternoclavicular joint defects.

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An Analysis of the Correlation between Temporal Bone Fracture and Potential Complications: Is There a Need for a New Classification System?

Skull Base ◽

10.1055/s-2009-1224479 ◽

2009 ◽

Vol 19 (S 02) ◽

Author(s):

D. Kikidis ◽

J. Thrasyvoulou ◽

P. Vlastarakos ◽

J. Xenelis ◽

A. Bibas

Keyword(s):

Temporal Bone ◽

Bone Fracture ◽

Classification System ◽

New Classification ◽

Temporal Bone Fracture

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Correlation between New Classification System for Reflux Laryngopharyngitis and Los Angeles Classification System for Reflux Esophagitis

Nihon Kikan Shokudoka Gakkai Kaiho ◽

10.2468/jbes.60.268 ◽

2009 ◽

Vol 60 (3) ◽

pp. 268-275

Author(s):

Kohei Nishimura ◽

Hiromasa Fujita ◽

Toshiaki Tanaka ◽

Yuichi Tanaka ◽

Satoru Matono ◽

...

Keyword(s):

Los Angeles ◽

Reflux Esophagitis ◽

Classification System ◽

New Classification ◽

Los Angeles Classification

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Faculty Opinions recommendation of Proposal of a new classification system for melanocytic naevi.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.715898063.791452859 ◽

2012 ◽

Author(s):

Cesare Massone

Keyword(s):

Classification System ◽

New Classification ◽

Melanocytic Naevi

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Role of Doppler ultrasonography in the evaluation of hemodialysis arteriovenous access maturation and influencing factors

The Journal of Vascular Access ◽

10.1177/1129729820965064 ◽

2021 ◽

pp. 112972982096506

Author(s):

Eva Chytilova ◽

Tamara Jemcov ◽

Jan Malik ◽

Jernej Pajek ◽

Branko Fila ◽

...

Keyword(s):

Vascular Access ◽

Doppler Ultrasonography ◽

Arteriovenous Graft ◽

Central Venous ◽

Preoperative Mapping ◽

High Incidence ◽

Arteriovenous Access ◽

Ultrasound Parameters ◽

Fistula Maturation

The goal of vascular access creation is to achieve a functioning arteriovenous fistula (AVF) or arteriovenous graft (AVG). An autologous fistula has been shown to be superior to AVG or to central venous catheters (CVCs) with lowest rate of re-intervention, but vessel obstruction or immaturity accounts for 20 % to 54% of cases with primary failure of AVF. This review is focused on the factors influencing maturation; indication and timing of preoperative mapping/creation of vascular access; ultrasound parameters for creation AVF/AVG; early postoperative complications following creation of a vascular access; ultrasound determinants of fistula maturation and endovascular intervention in vascular access with maturation failure. However, vascular accesses that fail to develop, have a high incidence of correctable abnormalities, and these need to be promptly recognized by ultrasonography and managed effectively if a high success rate is to be expected. We review approaches to promoting fistula maturation and duplex ultrasonography (DUS) of evaluating vascular access maturation.

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